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Sugar-sweetened sodas can lead to weight gain and diabetes, but a new study finds just how harmful the beverages can be on the heart, especially for men.

Researchers from the Harvard School of Public Health found that those drinking about 6.5 sugared beverages a week were 20% more likely to have a heart attack during the study’s nearly two decades than those who never consumed them.

The results came from 22 years of follow up of the eating habits and heart disease rates among 42,883 men enrolled in the Health Professionals Follow-Up Study. Every few years from January 1986 to December 2008, the participants, aged 40-75, answered questionnaires about their diet and health habits. They also provided blood samples halfway through the study so the researchers could measure possible confounding effects, such as cholesterol and glucose levels, as well as factors that could explain how excess sugar contributes to heart disease, such as inflammatory protein markers.

Indeed, the results show that men who sip more sugary beverages like sodas, lemonade and fruit drinks, have a higher risk of heart disease possibly due to increased levels of inflammation and harmful lipids in their blood, which are biomarkers for heart disease. The increased risk of heart disease remained even after the scientists accounted for other risk factors that could affect heart disease rates such as smoking, physical inactivity, alcohol use and family history of heart disease.

“This adds to the growing evidence that sugary beverages are detrimental to our health,” says study author Dr. Frank Hu, professor of nutrition and epidemiology in the Harvard School of Public Health. “There should be a concerted effort to reduce sugary beverage consumption in our population.” The same effect was not seen among those who drank artificially sweetened drinks, which don’t contain sugar. Men who drank sugar-sweetened beverages infrequently — only twice a week or twice a month — also did not experience an increased risk. Still, says Hu, that doesn’t mean it’s a good idea to consume diet drinks. “Less than one diet soda per day is probably okay, but we need more research. We also have much better alternatives like water and sweetened coffee and tea. We should consume those instead.”

And what about women? Although this study focused on men, in a 2009 study, Hu and his colleagues found that women who drank more than two servings of sugary beverages daily had a nearly 40 percent higher risk of heart disease than women who rarely drank sugary beverages.

“The results are basically the same for both men and women,” says Hu. “We should avoid sugary beverages as much as possible. These drinks should be occasional treats rather than a regular part of our diets.

The American Heart Association recommends limiting the daily amount of calories we consume in added sugars. Women should aim for no more than 100 calories per day, or about 6 teaspoons of sugar. For men, the recommendation is to top off at 150 calories per day, or about 9 teaspoons.

The study was published in the American Heart Association journal Circulation.